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OSCE by Mind Map: OSCE
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OSCE

History

Taking a drug and alcohol history

AimTo develop skills in taking an empathic and accurate alcohol history. Objectives Demonstrate empathic and non-judgmental questioning in relation to an alcohol history. Demonstrate techniques for quantifying alcohol consumption. Relate reported alcohol consumption to other clinical information and to relevant NHMRC guidelines. Demonstrate the ability to assess the presence of current or past alcohol use disorders (harmful alcohol consumption and alcohol dependence). Demonstrate the ability to assess evidence of physical, psychological, or social complications of drinking Demonstrate the ability to assess motivation to change drinking patterns, and the success of past efforts to change.

Check list, Introduction, Ensure privacy, Introduce yourself, Ask about name and age, Chief complain, (He will say he has a problem with drinking), History of presenting illness, Current consumption, Type of drink, Amount, Frequency, Pattern, Social drinking or binge drinking?, Alone or with somebody?, Any other substances?, Past consumption, When did you start?, Did the consumption increase over time (more tolerance)?, Complications, Blackouts, Morning shake or tremor, Withdrawal seizure, Delirium tremens (hallucinations), CAGE Questionnaire, Cut down on drinking (unsuccessful attempts), Annoyed by criticism of drinking by people, Guilt feeling for drinking, Eye-opener (need to drink in the morning to reverse withdrawal), COLD, only one is enough to diagnose abuse, CONSISTENCY in drinking, Failure to meet OBLIGATIONS, LEGAL troubles, Putting himself in DANGER, Past medical history, Any previous admissions or surgeries?, Any chronic diseases, Hypertension, Diabetes, CAD, Medications and allergies, Are on any medications?, Do you have any allergies?, Family history, Does drinking problems (or any other diseases) run in the family?, Social and occupational history, Occupational history, Type of work, Is it affected with the drinking problems?, Social history, Relationship status, Is personal and social life affected?, Financial impact, Related system review, GI, Sings of liver failure (Jaundice), Vomiting blood, Abdominal distension, Cardio, Blood pressure, Cholesterol, Nervous system, Mental problems, Depression, Suiciadal thoughts, Loss of sensation, Numbness, Ataxia

History of musculoskeletal disorder

Older patients

Functional impairment

Occupational history

Complete history check list, Introduction, Introduce yourself, Shake hands, Explain what you want and take permission, Get name, age, and birthdate, Chief complain, What are you complaining from?, History of presenting illness, SOCRATES, Site, What is the pain exactly?, Onset, When did it start?, Character, How is the pain like?, Radiation, Does the pain go to anywhere else?, Associated symptoms, Does the pain come with any other symptoms?, Nausea, vomiting, headache.. etc, Stiffness, swelling, weakness, or locking or joints?, Timing, Does the pain come and go or is it continues?, Exacerbating / alleviating factors, What makes the pain better?, What makes it worse?, Severity, From 1-10, FIFE, Feeling, How are you feeling about this pain?, Ideas, What do you think you have?, Functioning, How did this condition affect your functioning and daily life?, Expectations, Past history, Any chronic diseases?, Hypertension, Diabetes, Cholesterol, Any prevues hospital admissions or surgeries?, Drug history / allergy, Do you have any allergies?, Are you on any medications?, Family history, Are there any diseases that run in the family?, Occupational and social history, Occupational history, What's the current occupation and the previous ones?, How many hours do you work daily?, Describe a typical working day, Any accidents?, Have you taken time off from work because of this condition?, Is there job at risk?, Are you satisfied with your job?, Social history, Any functional difficulties?, Any life stressors or depression?, Are you living with somebody or alone?, Sexual history, Relationship statues, How many partners / their gender, smoking, alcohol, drugs, Review of systems, General symptoms, Well being, appetite, wight change, energy, sleep, mood, Then ask about related things to the patient's condition, e.g. patient with back pain ask about urination, Ask about things you forgot earlier, Dont forget to, Summarise what the patient says, Thank the patient and wish him good health

Physical examination

GALS screen

Check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients chest, upper & lower body (leave only underwear), Gait, Ask the patient to walk in a straight line then come back. Comment on:, Symmetry, Smoothness, Turning, Abnormalities, antalgia, waddling, festinant, wide based, high stepping?, Inspection, Front, Shoulder Bulk- deltoids, Elbow extension - normal carrying angle?, Quadriceps Bulk, Knee swelling / deformity, Foot arches - flat footed?, Mid-foot/ Forefoot deformity, Back, Shoulder muscle bulk, Muscle bulk at the trunk and legs, Gluteal muscle bulk, Straight spine? - scolliosis, Level iliac crests – pelvic tilt (symmetry), unilateral leg shortening, Popliteal Swellings – bakers cyst, Hind-foot abnormalities, Side, Cervical lordosis – normal, abnormal?, Thoracic Kyphosis, Lumbar Lordosis – loss of lordosis or hyperlordosis?, Knee flexion or Hyperextension, Arms, Stand infront of the patient, Press gently on each point of supraspinatus muscle to detect hyperalgesia, Ask patient to pace Hands behind head with elbows back - abduction & external rotation, Then ask him to put his arms straight in front of his body (elbow extension), Elbow flexion - "Bend the the arms up to touch your shoulder", Then ask him to put his hands to his sides, and extend elbow only, Pronation – “turn your palms downwards”, Swelling/Deformity of anterior wrists & hands?, Supination – “turn your palms up”, Swelling/Deformity of posterior wrists & hands?, Wrest flexion and extension, Test full finger extension at MCP, PIP, and DIP, Squeeze MCP and PIP joints – tenderness?, Palms – muscle bulk of thenar and hypothenar eminence, Power grip – “grip my fingers tightly”, Precision grip – “touch each finger in turn to your thumb“, Legs, Ask the patient to lie supine, Hip Passive flexion, Hip passive Internal and external Rotation (with hip and knee flexed at 90 degrees), feel crepitus patellofemoral joint, Palpate each knee for warmth or swelling, Patella Tap – large effusion?, Soles – callous formation or ulcers, Squeeze MTJ’s for tenderness, Spine, Stand behind the patient, Lumbar flexion (ask him to touch the toes), place 2 fingers on lumbar spine – as patient bends – fingers should move apart, Hold the pelvis and ask the patient to turn from side to side without moving his feet (thoracolumbar rotation), Ask the patient to slide the hand down the knee (lateral lumber flexion), Stand in front of the patient, Lateral cervical flexion – “touch your ear to your shoulder”, Ask him to look to the ceiling then down to the flood (cervical flexion and extension), TMJ joint – “move your jaw side to side”, FInish, Thank the patient, Wash hands, Summerize findings

Video

Drug and/or alcohol examination

Aim: To introduce students to the elements of the examination of a patient with drug and/or alcohol related problems.Objectives: Demonstrate the ability to perform a basic examination of a patient with drug and alcohol related problems.

Check list, Introduction, Wash hands, Approach to the patient - Rapport, empathy, and style, Ensure privacy, Introduce yourself, Explain what you would like to examine, Gain consent, Ask if patient has any pain anywhere before you begin!, Look at the patient from the end of the bed, Jaundice, Abdominal distention, Spider naevi, Caput medusa, Gynecomastia, Examine the hand, Leuconychia, Palmer erythema, Ask the patient to bend both hands back, Asterixis, Examine the eyes, Icterus, Nystagmus, Ophthalmoplegia, Cardiovascular exam, Pule, Blood pressure, Precordial examination and auscultation, Peripheral oedema, Respiratory exam, Abdominal exam, Asymmetry, Acsities, Hepatomegaly, Neurological exam, Tone, Cogwheel rigidity, Myoclunus, Tremor, Power, Loss of power, Quadriplegia, Reflexes, Sensation, Loss of sensation in the limbs and trunk, Coordination, Ataxia, Orientation, Confusion, Finish, Thank the patient, Wash hands, Summerize findings

Examination of the lower back and hips

Aim: To introduce students to the examination of the lower back and hips.Objectives: Demonstrate the ability to examine the normal low back and hip (ie. look, feel, move and measure). Describe the surface anatomy of the hip. Discuss gait as it relates to the hip. Demonstrate the ability to examine for the presence of neurological deficits in lower limbs relevant to back problems. Aim: To perform an examination of the hip joint.Objectives: Describe the surface anatomy of the hip joint. Describe the function and movements of the hip joint. Describe and demonstrate the examination of the hip joint. Describe normal and pathological gait patterns. Summarise the findings of a hip joint examination.

Hip exam, Check list, Introduction, Wash hands, Ensure privacy, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients legs and hips - keeping underwear on, Posisition – standing, Ask if patient has any pain anywhere before you begin!, Look, Look around bed for any aids or adaptations – walking stick, wheelchair, Inspect patient from 3 angles:, Front – Scars, Pelvic Tilt, Quadriceps Wasting, Side – Lumbar Lordosis (normal, loss of, hyperlordosis), Back – Gluteal Wasting, Gait - comment on speed, smoothness, turning (antalgic, high stepping, trendelenburg), Feel, Ask patient to lay on the bed, Feel for tenderness / warmth, Measure apparent leg length – xiphisternum to tip of medial malleolus, Measure true leg length – ASIS to tip of medial malleolus, Palpate greater trochanter - tenderness (bursitis), Move, Use your left hand to stabilise the contralateral ASIS to prevent masking of hip problems, Flexion (active) - “bring your knee towards your chest” – normal is 120°, Flexion (passive), Abduction (active & passive) - “keep leg straight & move away from the midline” – normal is 30-40°, Adduction (active & passive) – “keep leg straight & move it across the midline” – normal is 30°, Internal Rotation (active & passive) – “keep knees together & spread ankles” - normal 45°, External Rotation (active & passive) - “cross your legs over each other”, Position patient prone, Hip Extension – “lift your leg off the bed upwards” - normal is 10-15° (this is often not required in an OSCE situation), Special Tests, Trendelenburg’s Test, Place hands on the anterior superior iliac spines, Ask patient to lift right leg off floor, Watch your hands, Normally your left hand should rise as the pelvis tilts, Test is positive if left hand falls – left hip abductors not working, Repeat asking patient to lift left leg off floor, Thomas’s Test, Place left hand under patients spine, Ask patient to bring right knee up towards chest, Your hand should detect that the lumbar lordosis is now flattened, Once in full flexion look at the left leg, If it is still flat to the bed the test is negative (no fixed flexion deformity), In a positive test the left leg would begin to rise as the right hip is flexed, Repeat this time flexing the left hip, Finish, Thank tha patient, Wash hands, Summerize findings, Say you would examine one joint above (spine) and one joint below (knee)

Examination of the lower limb: knee and foot

Aim: To introduce students to the examination of the knee and foot.Objectives: Demonstrate the ability to examine the normal and arthritic knee and foot (ie. look, feel, move and measure). Demonstrate the ability to differentiate between mechanical and inflammatory causes of joint pain. Describe the distribution of major peripheral nerves. Perform tests of muscle power and range of motion for each joint. Observe gait and describe abnormalities. Aim: To perform an examination of the kneeObjectives: If the history suggests there has been an injury: Describe the surface anatomy and function of the knee joint. Describe the movements of the knee joint Describe and demonstrate examination of the knee joint, including checking for site of maximal tenderness, evidence of trauma and of joint instability Critically observe gait Summarise the findings of a knee joint examination If the history suggests knee arthritis: Describe the surface anatomy and function of the arthritic knee joint. Describe the movements of the arthritic knee joint Describe and demonstrate examination of the arthritic knee joint including checking for joint swelling, heat and erythema, and signs of a joint effusion Critically observe gait Summarise the findings of an arthritic knee joint examination

Knee exam, Check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients legs, Position – standing, Ask if patient has any pain anywhere before you begin!, Look, Inspect around bed for aids & adaptations - walking stick, wheelchair, knee brace, Inspect from 2 angles, front, Scars, Swellings, Asymmetry, Valgus or varus, Quadriceps swelling, back, Popliteal swellings, gait, Speed, Smoothness, Symmetry, Turning - quick, slow, Antalgia?, Feel, Ask patient to lay on bed, Temperature - palpate joints, Palpate Joint Lines – regular, rough, reduced (ask patient to flex knee slightly), Palpate collateral ligaments – either side of joint, Palpate patello-femoral joint, Sweep Test- (small effusion), Empty the media joint recess using a wiping motion, This milks any fluid into the lateral joint recess, Now do a similar wiping motion to the lateral recess, Watch the medial recess, If fluid is present a bulge will appear on medial recess, Patella Tap - (large effusion), Use your palm to milk fluid from the anterior thigh towards the patella, Keep tight hold of the thigh just above the patella, With the other hand press on the patella with two fingers, If fluid is present you will feel a distinct tap against the femur, Popliteal Swellings- (bakers cyst), Palpate the popliteal fossa with your finger tips, Feel for any obvious collections of fluids, Move, Flexion – ask patient to move heel towards bottom, Extension – ask patient to straighten leg, Hyperextension – watch patient lift leg off bed, then hold the feet stable and ask patient to relax, Special tests, Anterior/Posterior Drawer Test, Ask patient to flex knee at 90, Rest your forearm down the patients lower leg for stability, Wrap your fingers around back of the knee using both hands, Position thumbs over the patella, point at the ceiling, Push (posterior cruciate) or Pull (anterior cruciate), Normally there should be little or no movement seen, Collateral Ligaments, Hold just above the patients knee with one hand, Hold the patients lower leg with the other, Attempt to bend the lower leg medially (lateral collateral ligament), Attempt to bend the lower leg laterally (medial collateral ligament).., Finish, thank the patient, wash hands, summerize findings, Say you would examine one joint above (hip) and one joint below (ankle), Video

foot exam, Check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Ask if patient has any pain anywhere before you begin!, Look, ask the patient to take his shoes and socks, inspect the soles for any abnormal pattern of wear, Gait, increased high of step? (foot drop), ankle movement, Hallux rigidus (loss of MTP movement), Patient standing, look from behind, alignment of heel (varus or valgus?), from the side, position of longitudinal medial arch (flat foot?), if it's flattened, ask the patient to step on his toes, restored arch -> mobile deformity, not restored -> structural, splay foot? (widening at MTP, associated with synovities), inspect the hole foot for, scars, sinuses, swelling, bruising, callosities (thickening), oedema, deformity, Feel, tenderness, heat, swelling, Move, Dorsiflxion, Planterflexion, Inversion, Eversion, Special tests, Achillies tendon, ask the patient to kneel on both knees on a chair, palpate gasticnemius and achillies tendon for tenderness and swelling, Thomson's test, squeeze the calf of leg just distally to the maximum circumference, if the tendon is intact, planter flexion will occur

Upper limb: hand, wrist, elbow & forearm

Aim: To introduce students to the examination of the hand, wrist and forearm.Objectives: Demonstrate the ability to examine the normal hand, wrist and forearm. Describe the distribution of major peripheral nerves. Describe the major muscle groups in the forearm, wrist and hand and perform tests of muscle power and range of motion for each joint. Demonstrate the ability to examine the elbow and wrist joints. Describe the physical signs of arthritis in the hands.

Hand exam, Check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients hands, wrists and elbows, Position – hands on lap, on pillow with palms down, Ask if patient has any pain anywhere before you begin!, Look, Wrest drop, Dorsum, Scars, Deformity - Bouchards nodes (PIP) , Heberden’s nodes (DIP) – OA, Skin changes, Dorsal Muscle Wasting, Nails – pitting & onycholysis – Psoriasis, Swan neck deformity, Z-thumb, Boutonnières Deformity (button-hole), like the if the finger is pressing on a button, Palm, Scars – carpal tunnel release surgery, Swelling, Deformity - dupuytren’s contracture, affects the palmer facia causing MCP and PIP of little and ring fingers to become fixed in flexion, Thenar/ Hypothenar - wasting – carpal tunnel syndrome, Elbows – psoriatic plaques or rheumatoid nodules, Elbow, Scars, Nodules, Feel, Elbows, Feel along elbow & arm for nodules / tenderness, Palm, Thenar/ Hypothenar Bulk, Temperature - wrist & MCP joint lines, Tenderness, Palmar thickening, Radial pulses, Dorsum, MCP squeeze – often tender in RA / other inflammatory arthropathies, Sensation:, Median nerve - thenar eminence, Ulnar nerve - hypothenar eminence, Radial nerve - first dorsal web space, Palpate all joints:, Wrist, MTP, PIP, DIP, Move, Wrist extension – “prayer”, Wrist flexion – “reverse prayer”, Finger flexion - “make a fist”, Finger extension – “open your fist & splay your fingers”, Active Wrist / Finger Extension, Finger abduction - index finger, Finger adduction - you can use a paper, Thumb abduction – “don’t let me push your thumb into your palm”, Function (range of motion), Power grip, Pincer Grip, Pick up small object – small coin, Finish, Thank Patient, Wash Hands, summerize findings, Say you would examine the elbow if you did not, Carpal tunnel syndrom exam (median nerve injury), Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients hands and wrists, Ask if patient has any pain anywhere before you begin!, Look, muscle wasting in the thenar eminence, swelling, Feel, swelling, temperature, tenderness, Move, wrest extension and flexion, finger flexion and extension, thumb abduction, opposition, Neurological, power, weakness of thumb abduction and opposition, can ask the patient to grip your finger, sensation, reduced sensation at the median nerve distribution, Special tests, Phalen's sing, forced flexion of the wrest for 30 seconds, positive if it causes tingling in the affected fingers, Tinel's sign, percussion over the carpal tunnel, positive if it causes tingling in the affected fingers, Finish, Thank the patient, Wash hands, summarize findings, Say you would do nerve conduction studies and EMG to confirm, Video

Elbow exam, Check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients arm above the elbow, Ask if patient has any pain anywhere before you begin!, Look, Alignment of extended elbow, normally there is 11-13 degrees valgus, swellings, bruisings, scars, nodules, Feel, with elbow flexed at 90 degress, palpate bony parts of the lateral and medial epicodyles, olecranon tip, defining an equilateral triangle, feel also with elbow extended. detect any sponginess, focal tenderness?, Move, flexion and extension, ask the patient to touch his shoulder then straighten his elbow, range 0-145 degrees, pronation and supination, with elbow flexed at 90 degrees (at the patient side), supination 0-90 degrees, pronation 0-85 degrees, Special tests, Tennis elbow (lateral epicondylitis), with elbow flexed at 90 degrees, pronate and flex the hand fully, support the patient's elbows, and ask him to extend his flexed hand against your resistance, positive if there's pain at the lateral epicondyle (may be referred to the extensor aspect or arm), Golfer's elbow (medial epicodylitis), with elbow flexed at 90 degrees, supinate the hand fully, support the patient's elbows, and ask him to flex his flexed hand against your resistance, positive if there's pain at the medial epicondyle (may be referred to flexor aspect of arm), Finish, Thank the patient, Wash hands, Summarize findings, Say you would examine the shoulder and hand for completeness

The upper limb: shoulder and cervical and thoracic spine

Aim: To introduce students to the examination of the cervical spine, shoulder and upper back. To introduce students to reporting their examination findings.Objectives: Demonstrate the ability to examine the normal cervical spine, shoulder and upper back. Describe the major muscle groups in the shoulder, cervical spine and upper back. Demonstrate the ability to perform tests of muscle power and range of motion in the shoulder. Demonstrate the ability to report examination findings accurately and concisely for any of the examinations in this block.

Shoulder exam, Check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose patients upper body, Position – standing, Ask if patient has any pain anywhere before you begin!, Look, Look around bed for aids & adaptations – walking stick, wheelchair, Inspect patient from 3 angles, Front, Scars, Asymmetry of shoulder girdle - scolliosis, arthritis, previous trauma, Swelling - inflammatory joint disease, trauma, Muscle Wasting – Deltoid, Trapezius, Inspect the axilla too, Side, Scars – previous joint operations / trauma, Muscle wasting, Alignment of shoulder girdle - dislocated shoulder joint, Back, Scars, Trapezius - symmetry, wasting, Para-vertebral muscles - wasting, Scapula – symmetry, winged, Feel, Assess temperature of each shoulder joint, Assess each of the following joints for swelling & tenderness:, Sterno-clavicular joint, Clavicle, Acromio-clavicular joint, Subacromial space, Head of humorous, Greater and lesser tuberosity of humorous, bicipital groove, Coracoid Process, Spine of scapula, Feel muscle bulk of deltoid, Move, Flexion – “raise your arms forward above your head” - 150°-170°, Hyperxtension – “straighten your arms backwards as far as possible” - 40°, Abduction – “move your arms away up from the side until they point at the ceiling” - 160°-180°, Adduction – “move your arm across your body as far as you can” – 30°-40°, External Rotation – “hold elbows to your body flexed at 90, then move apart in an arc motion” – 70°, Internal Rotation – “move your arms back across your body, keeping your elbows at your side” – 70°, Do them again with resistance, Function, Stand behind the patient, Put your hands behind your head - external rotation + abduction, Put your hands as far up your back as your can - internal rotation + adduction, Special tests, The Painful Arc (rotator cuff lesion/tendonitis), Passively abduct arm fully, If rotator cuff lesion/tendonitis present pain will be felt between 40°-120°, You can also perform abduction against resistance which if painful further supports the diagnosis, Neer’s test (impingement), Ask patient to point there thumb down, Stabilise patients posterior shoulder, Passively raise patients arm upwards to 180° (abduction), Then ask the patient to lower it (adduct) slowly, Pain suggests impingement of posterior rotator cuff, Bicipital tendonitis, palpate the bicipital tendon noting any tenderness, ask the patient to supinate the forearm, and then flex against resistance, pain means positive tendonitis, To isolate subscapularis, internal rotation with the patient's hand behind his back, To isolate infraspinatus and teres minor, External rotation with the arm in 30 degrees flexion, Finish, Thank Patient, Wash hands, Summarize findings, Say you would examine one joint above (cervical spine) and one joint below (elbow), Video

Spine exam, Cervical spine check list, Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose neck and upper thorax, Position patient sitting on a chair, Ask if patient has any pain anywhere before you begin!, Look, Face the patient, Observe posture of head and neck, any abnormality or deformity, loss of lardosis?, Feel, Feel the midline spinous processes from the occiput to T1, Feel the paraspinal soft tissue, Feel the supraclavicular fossae, for cervical ribs, enlarged lymph nodes?, Feel the anterior neck structure, including the thyroid, Note any tenderness, Move, Assess active movements, Rotation, Ask the patient to look over the shoulder, then left, normal range 0-80 degrees, Flexion, Ask the patient to put his chin on his chest, normal range from 0-80 degrees, Extension, Look at the ceiling, range from 0-50 degrees, Lateral flexion, put the ear on the shoulder, range from 0-45 degrees, Do passive movement if active is not full range, note any resistance or pain, Neurological assessment of upper limb, Finish, Thank the patient, Wash hands, Summarize findings, Say you would examine the rest of the spine, Thoracic spine check list, I did not make it yet because we did not take it in the session, Full spine exam check list (this is NOT in the objectives), Introduction, Wash hands, Introduce yourself, Explain what you would like to examine, Gain consent, Expose upper body, Position patient standing, Ask if patient has any pain anywhere before you begin!, Look, Look for aids & adaptations - walking stick, wheelchair, Assess Gait - smoothness, speed, symmetry, turning, antalgic?, Inspect the patient from 3 angles, Behind, Scars, Wasting, Scoliosis, Abnormal hair growth, Side, Cervical lordosis - normal/abnormal?, Thoracic Kyphosis – normal/abnormal?, Lumbar Lordosis – normal/hyperlordosis/loss of lordosis?, Front, Abnormal posture, Symmetry of shoulders – wasting?, Feel, Palpate spinal processes & sacroiliac joints - tenderness & alignment, Palpate paraspinal muscles - tenderness or spasms, Move, Cervical, Flexion – “touch your chin to your chest”, Extension – “look up at the ceiling”, Lateral Flexion – “touch your ear to your shoulder”, Rotation – “turn your head to the left & then to the right”, Lumbar, Flexion – “touch your toes”, Extension -”lean backwards” (stand behind patient to ensure they don’t fall), Lateral flexion – “slide your hand down your leg”, Thoracic, Rotation- sit the patient down, with arms crossed across chest & ask to turn side to side, Special tests for lumber spine, Schober’s Test - tests the range of motion in lumbar spine, Identify position of the posterior superior iliac spine, Mark midline 5cm below iliac spine, Mark midline 10cm above iliac spine, Ask patient to bend forward in full lumbar flexion, Measure the distance between the two lines (started at 15cm), Reduced range of motion can indicate Ankylosing Spondylitis, Sciatic Stretch Test (Leg raising), Hold ankle & lift leg straight to 90 degrees, Dorsiflex foot, Positive = pain felt in back of thigh, Femoral Nerve Stretch Test, Position patient prone, Flex knee, Extend hip, Plantar-flex foot, Positive test = pain felt in thigh/ inguinal region, Finish, Thank patient, Wash Hands, Video for full spine exam